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Hemorrhoids

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Updated 2024 ASCRS guidelines for the diagnosis and management of hemorrhoids.

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of hemorrhoids are prepared by our editorial team based on guidelines from the American Society of Colon and Rectal Surgeons (ASCRS 2024), the American College of Gastroenterology (ACG 2021,2014), the World Society of Emergency Surgery (WSES/AAST 2021), and the American Academy of Family Physicians (AAFP 2018). ...
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Diagnostic investigations

History and physical examination: as per ASCRS 2024 guidelines, elicit a disease-specific history and perform a physical examination emphasizing the degree and duration of symptoms and risk factors.
B
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  • Laboratory tests

  • Diagnostic imaging

Diagnostic procedures

Colonoscopy: as per ASCRS 2024 guidelines, obtain complete endoscopic evaluation of the colon in selected patients with symptomatic hemorrhoids and rectal bleeding.
B

Medical management

Pharmacotherapy: as per ASCRS 2024 guidelines, consider offering medical therapy in patients with hemorrhoids, recognizing that although representing a heterogeneous group of treatment options, it carries minimal harm and has potential for symptomatic relief.
C

Nonpharmacologic interventions

Dietary modifications: as per ASCRS 2024 guidelines, advise dietary and behavioral modifications as the primary first-line therapy in patients with symptomatic hemorrhoids.
B

Therapeutic procedures

Office-based procedures: as per ASCRS 2024 guidelines, consider offering office-based procedures in patients with grade I or II hemorrhoids and selected patients with grade III hemorrhoids refractory to conservative treatment. Recognize that hemorrhoid banding is typically the most effective office-based treatment.
B

Surgical interventions

Early excision of thrombosed external hemorrhoids: as per ASCRS 2024 guidelines, consider performing early surgical excision in selected patients with thrombosed external hemorrhoids.
C

More topics in this section

  • Excisional hemorrhoidectomy

  • Stapled hemorrhoidopexy

  • Hemorrhoidal artery ligation